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摘要：目的：观察胶原酶联合经皮椎间孔镜治疗脱出型腰椎间盘突出症临床疗效。方法：选择单间隙脱出型腰椎间盘突出症患者38名，随机分为单纯椎间孔镜组和联合胶原酶组。用视觉模拟评分法（VAS）及MacNab标准评价比较两组治疗效果。结果：两组患者手术后的VAS评分与术前比较有显著性差异（P<0.05），两组术后3天的VAS评分比较有显著性差异（P<0.05），两组术后6月、术后12月的VAS评分有显著性差异（P<0.05）。按照改良MacNab疗效评定标准，联合胶原酶组治疗后12月的优秀率为73.7%，与椎间孔镜组比较有显著性差异（P<0.05）。结论：经皮椎间孔镜联合胶原酶和单纯经皮椎间孔镜治疗脱出型腰椎间盘突出症均有效果，但前者的远期疗效更可靠。
关键词：腰椎；椎间盘；胶原酶；经皮椎间孔镜下腰椎间盘切除术
【Abstrct】 Objective the clinical therapeutic effect about the collagenase with percutaneous intervertebral foramen mirror treating the lumbar disc hernia type.Methods：Select 38 patients with single gap lumbar disc prolapse type，which were randomly divided into pure intervertebral foramen and combined collagenase groups.Using visual analogue scale（VAS）and MacNab criteria evaluation of comparing two groups of therapeutic effect.Results：the VAS score of the two groups patients had significant difference between the post-operation and the pre-operation（P < 0.05），the VAS score of the two groups patients had more significant difference in the post-operation 3 days（P < 0.05），the post-operation VAS score of the two groups patients had significant difference in 6 month and in 12 month.（P < 0.05）.According to the modified MacNab therapeutic effect evaluation standard，the proficiency was 73.7% after combined collagenase treatment groupin 12 monthr，which had the significant difference compared with intervertebral foramen lens group（P < 0.05）.Conclusion：The percutaneous intervertebral foramen mirror combined collagenase and the pure percutaneous intervertebral foramen mirror treatiing the lumbar intervertebral disc type are effective，but the former is more reliable with the long-term curative effect.
【Key words】Lumbar vertebra；Intervertebral disk；collagenase；Pereutaneous transforaminal endoscopic discectomy
腰椎間盘突出症传统手术治疗可以改善症状，但手术创伤大、费用昂贵、恢复时间较长，因此经皮椎间孔镜下腰椎间盘切除术（pereutaneoustransforaminal endoscopic discectomy，PTED）等微创技术得到更多的应用[1]。针对脱出型腰椎间盘突出症患者，尤其是游离型，由于突出物巨大，部分髓核组织已被挤入椎管内，出现向上或向下移位，单靠在椎间孔镜下的夹取，很难彻底清除局部压迫，以至于影响手术效果。胶原酶可以促使突出的椎间盘的溶解并吸收，也是治疗椎间盘突出症的手段之一[2]。本研究旨在探讨经皮椎间孔镜联合胶原酶治疗腰椎间盘突出症的术后近期和远期效果。
1 临床资料与方法
1.1 一般资料
2012年4月-2012年12月于自治区职业病医院疼痛科收治的单间隙、脱出型腰椎间盘突出症（MRI或CT提示分型）患者38名，临床表现为腰痛伴一侧下肢放射痛，无椎间盘严重钙化，无腰椎管狭窄，无椎体不稳、滑脱，无脊柱感染、结核、肿瘤，经保守治疗（至少3个月）后无效或复发。入选患者随机分为单纯椎间孔镜组（对照组）和联合胶原酶组（治疗组），随访过程中对照组失访一例，未纳入数据统计。对照组：男10例，女8例；年龄平均（53.8±13.8）岁；病程平均（5.4±3.9）年；手术时间平均（70.3±23.0）分钟；其中L3-4 14例，L4-5 4例。治疗组：男12例，女7例；年龄平均（50.4±12.6）岁；病程平均（4.3±4.3）年；手术时间平均（67.1±21.4）分钟；其中L3-4 13例，L4-5 6例。
关键词：腰椎；椎间盘；胶原酶；经皮椎间孔镜下腰椎间盘切除术
【Abstrct】 Objective the clinical therapeutic effect about the collagenase with percutaneous intervertebral foramen mirror treating the lumbar disc hernia type.Methods：Select 38 patients with single gap lumbar disc prolapse type，which were randomly divided into pure intervertebral foramen and combined collagenase groups.Using visual analogue scale（VAS）and MacNab criteria evaluation of comparing two groups of therapeutic effect.Results：the VAS score of the two groups patients had significant difference between the post-operation and the pre-operation（P < 0.05），the VAS score of the two groups patients had more significant difference in the post-operation 3 days（P < 0.05），the post-operation VAS score of the two groups patients had significant difference in 6 month and in 12 month.（P < 0.05）.According to the modified MacNab therapeutic effect evaluation standard，the proficiency was 73.7% after combined collagenase treatment groupin 12 monthr，which had the significant difference compared with intervertebral foramen lens group（P < 0.05）.Conclusion：The percutaneous intervertebral foramen mirror combined collagenase and the pure percutaneous intervertebral foramen mirror treatiing the lumbar intervertebral disc type are effective，but the former is more reliable with the long-term curative effect.
【Key words】Lumbar vertebra；Intervertebral disk；collagenase；Pereutaneous transforaminal endoscopic discectomy
腰椎間盘突出症传统手术治疗可以改善症状，但手术创伤大、费用昂贵、恢复时间较长，因此经皮椎间孔镜下腰椎间盘切除术（pereutaneoustransforaminal endoscopic discectomy，PTED）等微创技术得到更多的应用[1]。针对脱出型腰椎间盘突出症患者，尤其是游离型，由于突出物巨大，部分髓核组织已被挤入椎管内，出现向上或向下移位，单靠在椎间孔镜下的夹取，很难彻底清除局部压迫，以至于影响手术效果。胶原酶可以促使突出的椎间盘的溶解并吸收，也是治疗椎间盘突出症的手段之一[2]。本研究旨在探讨经皮椎间孔镜联合胶原酶治疗腰椎间盘突出症的术后近期和远期效果。
1 临床资料与方法
1.1 一般资料
2012年4月-2012年12月于自治区职业病医院疼痛科收治的单间隙、脱出型腰椎间盘突出症（MRI或CT提示分型）患者38名，临床表现为腰痛伴一侧下肢放射痛，无椎间盘严重钙化，无腰椎管狭窄，无椎体不稳、滑脱，无脊柱感染、结核、肿瘤，经保守治疗（至少3个月）后无效或复发。入选患者随机分为单纯椎间孔镜组（对照组）和联合胶原酶组（治疗组），随访过程中对照组失访一例，未纳入数据统计。对照组：男10例，女8例；年龄平均（53.8±13.8）岁；病程平均（5.4±3.9）年；手术时间平均（70.3±23.0）分钟；其中L3-4 14例，L4-5 4例。治疗组：男12例，女7例；年龄平均（50.4±12.6）岁；病程平均（4.3±4.3）年；手术时间平均（67.1±21.4）分钟；其中L3-4 13例，L4-5 6例。